Health, 2019, 11, 1396-1413 https://www.scirp.org/journal/health ISSN Online: 1949-5005 ISSN Print: 1949-4998 Designing a Need Based Social Protection Intervention Package for Children and Adolescents Living with HIV and AIDS in Ghana —An Eclectic Perspective on Desired Social Protection Intervention Package/Framework Seth Christopher Yaw Appiah1,2* , Adeyemi Olu Adekunle3, Adesina Oladokun3, Jonathan Mensah Dapaah2, Karikari Mensah Nicholas4 1Pan African University Institute of Life and Earth Sciences Including Health and Agriculture University of Ibadan (PAULESI), Ibadan, Nigeria 2Department of Sociology and Social Work, Faculty of Social Sciences, Kumasi College of Humanities and Social Science, Nkrumah University of Science and Technology, Kumasi, Ghana 3Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria 4Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana How to cite this paper: Appiah, S.C.Y., Abstract Adekunle, A.O., Oladokun, A., Dapaah, J.M. and Nicholas, K.M. (2019) Designing a Need Background: Designing a need-based social protection intervention for child- Based Social Protection Intervention Pack- ren comes as comprehensive tool for addressing the overall quality of life of age for Children and Adolescents Living HIV positive children. Not much has been examined on what constitute the with HIV and AIDS in Ghana—An Eclectic Perspective on Desired Social Protection desired social protection framework for HIV positive children. Methods: This Intervention Package/Framework. Health, study was informed by a qualitative descriptive exploratory design approach. 11, 1396-1413. The study drew insights from the shared perspectives of 27 participants sam- https://doi.org/10.4236/health.2019.1110107 pled from positive HIV status disclosed children—10 - 17 years, healthcare Received: September 16, 2019 workers, Social and Development worker, HIV positive caregivers and par- Accepted: October 20, 2019 ents from 7 ART clinics in rural and urban Brong Ahafo and Ashanti regions Published: October 23, 2019 of Ghana. Data was collected through interviews and two focus group discus- sions with study participants. Drawing on the emerged themes from the Copyright © 2019 by author(s) and Scientific Research Publishing Inc. transcripts, thematic content analysis was used to analyze the data using This work is licensed under the Creative comparative thematic framework approach. Findings: The eclectic perspec- Commons Attribution International tives on the type of social protection policy/intervention preferred demon- License (CC BY 4.0). strated the need for an interrelated and integrated social protection policy. http://creativecommons.org/licenses/by/4.0/ This should not be designed in isolation towards addressing the child vulne- Open Access rability. The study found that social protection policies aimed at addressing vulnerability levels of children should consider the dual vulnerability situa- DOI: 10.4236/health.2019.1110107 Oct. 23, 2019 1396 Health S. C. Y. Appiah et al. tion within which HIV positive children and adolescents are located. A set of unique specific tailored approach and package reflecting minimum combina- tion social protection package to HIV positive children was considered essen- tial for inclusion. The themes that emerged covered social policy/intervention package inclusive of a disease ending/eradication intervention package, cash transfer for children and their caregivers, free comprehensive health insur- ance integrating all consultancy and laboratory services charges, direct food supplements supply and nutritional support, research, target specified with evidenced-based monitoring. Counseling support and preferential treat- ment for children visiting ART for treatment were to be included. Conclu- sion: Combination social protection intervention packages remain the path- way to yielding maximum dividends on any social intervention that seeks to address the vulnerability levels of HIV positive children in Ghana. This should be designed taking into consideration the preference of the main tar- get beneficiaries (HIV positive children) while accounting for the inclusion of the technical expertise of implementing stakeholders in the policy design from conceptualization to evaluation. Keywords Social Protection, HIV and AIDS Infected Children, Adolescent’s, Intervention, Ghana 1. Background Sub-Saharan Africa continues to share the greatest number of HIV and AIDS infected children despite the gains made globally in addressing the HIV/AIDS epidemic [1]. A multi sectoral approach and perspectives have been shared on how to address the multiplicity of challenges that comes along with caring for HIV and AIDS infected children. This has been due to the increased survival of children resulting improved medication. This has necessitated that stakeholders refocus attention not only on biomedical approaches to treatment and preven- tion but also livelihood and socio-behavioural dimensions of the illness. The search for a combination intervention to address the needs of HIV and AIDS in- fected children due to the multidimensional effect of HIV illness on them has been a long-standing academic inquiry. Scholars such as McCord and Himmelstine and Pettifor and colleagues have reiterated such calls [2] [3]. In 2004, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) initiated a Public-Private Partnered intervention in ten African countries and dubbed the intervention Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS). However, Ghana was not included in the programme because the programme was implemented for adolescent girls in high HIV burden countries within the Sub-Saharan Africa [1]. This intervention brings to the fore how the need to de- sign cross approach intervention has been earmarked on the international child DOI: 10.4236/health.2019.1110107 1397 Health S. C. Y. Appiah et al. and adolescent HIV and AIDS agenda. However, the bigger focus of the DREAM intervention was on HIV prevention. The necessity of designing evidence-based interventions to address cross cut- ting issues for HIV positive children has been justified elsewhere [4]. It has been found that standalone single intervention offers little results in addressing the multifaceted vulnerability context factors of HIV positive children [4] [5]. This is as a result of the complex factors that HIV and AIDS positive children find themselves. There is evidence that suggests that, combination social protection interven- tions are able to reduce child vulnerability levels [5]. In some reported studies, these combination interventions ought to include economic, social and biomed- ical packages. However, the generic mention of such packages makes it difficult in identifying the specific composition of package that will yield the required reduction in child vulnerability levels. This is because, several interventions come under each of the thematic programmes that have been noted to yield pos- itive outcomes in reducing child vulnerability. International child focused or- ganizations such as UNICEF posits that, designing such HIV positive social in- terventions should be inclusive and as well have education and health packages [6]. In Ghana, significant number of children continue to live in vulnerable con- text with less holistic social support interventions designed for them [7]. Despite the acknowledged impact of Ghana Livelihood Empowerment Against Poverty programme in offering social protection by improving the wellbeing of orphans and vulnerable children, the entire spectrum of the intervention reach- ing HIV positive children has not been analysed [7] [8] [9]. The unique needs of such vulnerable population in terms of programme design and implementation remains absent. The specific tailored social protection intervention that meets the needs of all stakeholders who directly address the vulnerability levels of HIV positive children are difficult to come by among studies reporting on social pro- tection for HIV children in Ghana. It remains contested on what the nature of social protection programmes for HIV positive children ought to be for Ghanaian HIV and AIDS infected children. A minimum standard package of what best fit, acceptable and evidence based package is needed to address the double vulnerability space of HIV and AIDS infected children. This calls for an empirical study of what is desired. In this study, an attempt is made to find out from stakeholders including children HIV and AIDS positive children, caregivers, positive HIV and AIDS parents, social workers, medical doctors, nutritionist and clinical nurses on the minimum package that is desired to be included in any social protection policy framework for HIV and AIDS infected children. 2. Methods 2.1. Setting The study was carried out in the Ashanti and Brong Ahafo regions of Ghana DOI: 10.4236/health.2019.1110107 1398 Health S. C. Y. Appiah et al. between March 2018 and June 2019. The two regions have been consistent in the past 3 years in recording higher national HIV prevalence levels in Ghana. In 2018, Bono region recorded an HIV prevalence of 2.48 per cent while the Ahafo region recorded 2.66% in HIV prevalence. The prevalence suggests that accord- ing to the previous ten regions of Ghana, the Brong Ahafo topped in the HIV prevalence rates in Ghana followed by the Ashanti region. According to the new 16 regions of Ghana, the highest prevalence was recorded by Ahafo region (2.66%) followed